Case Study: Mr. M

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Case Study: Mr. M

Mr. M., a thirty-two-year-old postal worker, had been married for eight years. He and his wife lived comfortably and happily in a middle-class neighborhood with their two children. In retrospect there appeared to be no warning for what was to happen. On February the twelfth Mr. M. let his wife know that he was bursting with energy and ideas, that his job as a mail carrier was unfulfilling, and that he was just wasting his talent. That night he slept little, spending most of the time at a desk, writing furiously. The next morning he left for work at the usual time but returned home at eleven a.m., his car filled to overflowing with aquaria and other equipment for tropical fish. He had quit his job and then withdrawn all the money from the family's savings account. The money had been spent on tropical fish equipment. Mr. M. reported that the previous night he had worked out a way to modify existing equipment so that fish "won't die anymore. We'll be millionaires." After unloading the paraphernalia, Mr. M. set off to canvass the neighborhood for possible buyers, going door to door and talking to anyone who would listen.

The following bit of conversation from the period after Mr. M. entered treatment indicates his incorrigible optimism and provocativeness.

Therapist: Well, you seem pretty happy today.

Client: Happy! Happy! You certainly are a master of understatement, you rogue! (Shouting, literally jumping out of his seat.) Why I'm ecstatic. I'm leaving for the West Coast today, on my daughter's bicycle. Only 3100 miles. That's nothing, you know. I could probably walk, but I want to get there by next week. And along the way I plan to contact a lot of people about investing in my fish equipment. I'll get to know more people that way-you know, Doc, "know" in the biblical sense (leering at the therapist seductively).

Case Study: Mr. J

Mr. J. was a fifty-one-year-old industrial engineer who, since the death of his wife five years earlier, had been suffering from continuing episodes of melancholy marked by extreme social withdrawal and occasional thoughts of suicide. His wife had died in an automobile accident during a shopping trip which he himself was to have made but had canceled because of professional responsibilities. His self-blame for her death, which became evident immediately after the funeral and was regarded by his friends and relatives as transitory, deepened as the months, and then years, passed by. He began to drink, sometimes heavily, and when thoroughly intoxicated would plead to his deceased wife for forgiveness. He lost all capacity for joy, his friends could not recall when they had last seen him smile. Once a gourmet, he now had no interest in food and good wine, and on those increasingly rare occasions when friends invited him for dinner, this previously witty, urbane man could barely manage to engage in small talk. As might be expected, his work record deteriorated markedly. Appointments were missed and projects haphazardly started and then left unfinished.

Case Study: The Salesman

A 29-year-old car salesman was referred by his current girl friend, a psychiatric nurse, who suspected he had a Mood Disorder, even though the patient was reluctant to admit that he might be a "moody" person. According to him, since the age of 14 he has experienced "good times and bad times." During a "bad" period, usually lasting four to seven days, he oversleeps 10-14 hours daily, lacks energy, confidence, and rnotivation - "just vegetating," as he puts it. Often he abruptly shifts, characteristically upon waking up in the morning, to a three-to-four-day stretch of overconfidence, heightened social awareness promiscuity, and sharpened thinking things would flash in my mind." At such times he indulges in alcohol to enhance the experience, but also to help him sleep. Occasionally the "good" periods last seven to ten days, but culminate in irritable and hostile outbursts, which often herald the transition back to another period of "bad" days. He admits to frequent use of marijuana, which he claims helps him "adjust" to daily routines.

In school, A's and B's alternated with C's and D's, with the result that the patient was considered a bright student whose performance was mediocre overall because of "unstable motivation". As a car salesman his performance has also been uneven, with "good days" canceling out the "bad days"; yet even during his "good days" he is sometimes perilously argumentative with customers and loses sales that appeared sure. Although considered a charming man in many social circles, he alienates friends when he is hostile and irritable. He typically accumulates social obligations during the "bad" days and takes care of them all at once on the first day of a "good period". (Spitzer et al., 1994, pp. 155-56)

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